This project develops and implements technical cost reduction procedures for community hospitals. Earlier work by this group has indicated that certain systems are central to success. These systems provide: (1) an adequate, but not excessive inpatient bed supply, (2) scheduling for a majority of elective patients with high occupancy and appropriate provision for emergencies, (3) pre-admission testing and scheduling of diagnostic and therapeutic services to reduce length of stay. The first two systems are complete and are entering extended application in numerous Michigan sites. Evaluation and improvement are continuing concurrently. The third area is in preliminary implementation and study. Bed need determination methods are based on empirical patient service area determination, normative selection of patient day use rates (except obstetrics), and empirical justification of occupancy (from admission scheduling system and simulation models). Admission scheduling includes simulation model for establishing policy decisions, a game for teaching operators. Number of scheduled patients is set to maximize occupancy, subject to normatively acceptable levels of emergency over-crowding, in-house transfers, cancellation rates. These schedule limits are manually implemented. Various publications available or in process. Contact principal investigator for current information. Other work, not currently pursued, includes nurse scheduling algorithms, use of payroll and budget data in cost information systems.